Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

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Long-term outcomes of transvaginal mesh surgery for pelvic organ prolapse: a retrospective cohort study

BMC Women s Health ◽

10.1186/s12905-021-01505-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojuan Wang ◽

Yisong Chen ◽

Changdong Hu ◽

Keqin Hua

Keyword(s):

Pelvic Organ Prolapse ◽

Patient Characteristics ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Recurrence Rates ◽

Kaplan Meier ◽

Mesh Surgery ◽

Patient Global Impression

Abstract Background The objective of this study was to evaluate the overall outcomes and complications of transvaginal mesh (TVM) placement for the management of pelvic organ prolapse (POP) with different meshes with a greater than 10-years of follow-up. Methods We performed a retrospective review of patients with POP who underwent prolapse repair surgery with placement of transvaginal mesh (Prolift kit or self-cut Gynemesh) between January 2005 and December 2010. Baseline of patient characteristics were collected from the patients’ medical records. During follow-up, the anatomical outcomes were evaluated using the POP Quantification system, and the Patient Global Impression of Improvement (PGI-I) was used to assess the response of a condition to therapy. Overall postoperative satisfaction was assessed by the following question: “What is your overall postoperative satisfaction, on a scale from 0 to 10?”. Relapse-free survival was analyzed using Kaplan–Meier curves. Results In total, 134 patients were included. With a median 12-year (range 10–15) follow-up, 52 patients (38.8%) underwent TVM surgery with Prolift, and Gynemesh was used 82 (61.2%). 91% patients felt that POP symptom improved based on the PGI-I scores, and most satisfied after operation. The recurrence rates of anterior, apical and posterior compartment prolapse were 5.2%, 5.2%, and 2.2%, respectively. No significant differences in POP recurrence, mesh-associated complications and urinary incontinence were noted between TVM surgery with Prolift versus Gynemesh. Conclusions Treatment of POP by TVM surgery exhibited long-term effectiveness with acceptable morbidity. The outcomes of the mesh kit were the same as those for self-cutmesh.

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Transvaginal mesh technique for pelvic organ prolapse repair: mesh exposure management and risk factors

International Urogynecology Journal ◽

10.1007/s00192-005-0003-8 ◽

2005 ◽

Vol 17 (4) ◽

pp. 315-320 ◽

Cited By ~ 183

Author(s):

Pierre Collinet ◽

Franck Belot ◽

Philippe Debodinance ◽

Edouard Ha Duc ◽

Jean-Philippe Lucot ◽

...

Keyword(s):

Risk Factors ◽

Pelvic Organ Prolapse ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Prolapse Repair ◽

Pelvic Organ Prolapse Repair ◽

Mesh Technique

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Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up

European Urology Supplements ◽

10.1016/s1569-9056(19)33514-6 ◽

2019 ◽

Vol 18 (9) ◽

pp. e3177

Author(s):

S. Serni ◽

S. Morselli ◽

P. Verrienti ◽

M. Di Camillo ◽

L. Gemma ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Sexual Function ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Surgery ◽

Long Term Follow Up

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

10.21203/rs.3.rs-38744/v1 ◽

2020 ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate ◽

Surgical Treatments

Abstract Background The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse, and to analyze the management and relief of the pain. Methods A retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analyzed. Results The incidence of pain after TVM surgery was 2.70% (50/1855), with a median occurrence time of 7.5 months. Pain symptoms mainly involved vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Greater intraoperative blood loss (OR = 1.284, 95%CI 0.868–2.401) and postoperative anatomic failure (OR = 1.577, 95%CI 0.952–3.104) were analyzed as risk factors with statistical significance. Mesh exposure rate in pain group was 38%, showing a significant difference between groups (P < 0.01). Forty patients underwent non-surgical treatments, with a relief rate of 40.0%; 33 patients were performed surgical treatments, 15 of which underwent partial mesh removal and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. Conclusions Excessive intraoperative bleeding and postoperative anatomic failure can increase the risk of postoperative pain; mesh exposure, mesh contracture, and mesh position abnormality are also associated. Most patients can get pain relief with proper management, more than half of which may need mesh removal with differing amounts.

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

BMC Women s Health ◽

10.1186/s12905-021-01192-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate

Abstract Background The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain. Methods A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed. Results A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR = 1.284, 95% CI 0.868–2.401) and postoperative anatomic failure (OR = 1.577, 95% CI 0.952–3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P < 0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain. Conclusions Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.

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Transvaginal mesh surgery for pelvic organ prolapse does not affect sexual function at long term follow up

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2019.07.027 ◽

2019 ◽

Vol 240 ◽

pp. 282-287

Author(s):

Simone Morselli ◽

Vincenzo Li Marzi ◽

Pierangelo Verrienti ◽

Maurizio Serati ◽

Matteo Di Camillo ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Sexual Function ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Surgery ◽

Long Term Follow Up

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Clinical analysis of pain after transvaginal mesh surgery in patients with pelvic organ prolapse

10.21203/rs.3.rs-38744/v2 ◽

2020 ◽

Author(s):

Chang Shi ◽

Ying Zhao ◽

Qing Hu ◽

Runqi Gong ◽

Yitong Yin ◽

...

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Statistical Significance ◽

Pelvic Organ ◽

Transvaginal Mesh ◽

Mesh Exposure ◽

Mesh Removal ◽

Mesh Surgery ◽

Significant Difference ◽

Relief Rate

Abstract Background: The purpose of this study was to investigate the relevant factors of pain after transvaginal mesh (TVM) surgery for the treatment of pelvic organ prolapse and to analyse the management and relief of the pain.Methods: A multicentre retrospective study of a clinical database of patients who underwent TVM surgery was conducted, and pain related aspects were analysed.Results: A total of 1855 patients were included in the study. We divided the patients into two groups: pain-free (1805 patients) and pain (50 patients) group. The incidence of pain after TVM surgery was 2.70%, with a median occurrence time of 7.5 months. Pain mainly involved the vagina, perineum, buttocks, groin, inner thighs, and lower abdomen. Excessive intraoperative blood loss (OR=1.284, 95%CI 0.868-2.401) and postoperative anatomic failure (OR=1.577, 95%CI 0.952-3.104) were analysed as risk factors with statistical significance. Mesh exposure rate in the pain group was 38%, showing a significant difference between the groups (P<0.01). Forty patients underwent non-surgical treatment, with a relief rate of 40.0%, 33 patients received surgical treatment, 15 underwent partial mesh removal, and 18 underwent complete mesh removal, with a relief rate of 84.8%. The total relief rate was 88% within all 50 patients suffering from pain.Conclusions: Excessive intraoperative bleeding and unsatisfactory postoperative anatomic outcomes can increase the risk of postoperative pain; mesh exposure is also associated with the pain. Most patients can get pain relief with proper management, more than half of whom may need mesh removal with differing approach.

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Vaginal mesh surgery is efficient to treat pelvic organ prolapse grade 3 in elderly women

Fundamental and Clinical Medicine ◽

10.23946/2500-0764-2019-4-4-38-46 ◽

2019 ◽

Vol 4 (4) ◽

pp. 38-46

Author(s):

O. S. Korotkevich ◽

V. G. Mozes ◽

I. A. Eizenakh ◽

A. V. Soloviev ◽

V. V. Vlasova

Keyword(s):

Surgical Treatment ◽

Pelvic Organ Prolapse ◽

Outcome Measure ◽

Elderly Women ◽

Pelvic Organ ◽

Vaginal Mesh ◽

Mesh Surgery ◽

Grade 3

Aim. To evaluate the surgical treatment of pelvic organ prolapse grade 3 in elderly women.Materials and Methods. We consecutively recruited 86 elderly women (60 to 75 years old) suffering from pelvic organ prolapse grade 3. Out of them, 56 patients underwent vaginal mesh surgery while 30 refused surgical treatment. After 1 year, we assessed stress urinary incontinence using a cough test and Valsalva maneuver. Pain intensity was measured using the Numeric Rating Scale whereas quality of life was assessed by Pelvic Floor Disability Index (PDFI-20). The primary outcome measure was the prevalence of pelvic organ prolapse symptoms while the secondary outcome measure was the frequency of stress urinary incontinence and low quality of life upon 1 year of follow-up.Results. After 1 year of follow-up, patients who received a surgical treatment were characterized by a statistically significant decrease in both frequency and intensity of complaints and symptoms of pelvic organ prolapse. Pelvic Organ Prolapse Distress Inventory score was 8.3 (4.2-12.5) and 79.2 (79.2-100) in patients with or without surgical treatment respectively. Similar results were showed using Colorectal-Anal Distress Inventory score (6.2 (3.1-6.2) and 68.8 (62.5-71.9) and Urinary Distress Inventory score (8.3 (4.2-8.3) and 83.3 (79.2-87.5), in treated and untreated individuals, respectively. Total Pelvic Floor Disability Index score was 22.8 (11.5-27.0) in women who underwent a vaginal mesh surgery and 227.2 (226.1251.0) in those who did not. All indicated differences were statistically significant.Conclusions. Vaginal mesh surgery is efficient for the treatment of pelvic organ prolapse grade 3 in elderly women.

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Pelvic Organ Prolapse Repair with Mesh: Description of Surgical Technique Using the Surelift® Anterior Repair System

Urologia Internationalis ◽

10.1159/000510530 ◽

2020 ◽

pp. 1-6

Author(s):

Laura Mateu-Arrom ◽

Cristina Gutiérrez-Ruiz ◽

Joan Palou Redorta ◽

Carlos Errando-Smet

Keyword(s):

Pelvic Organ Prolapse ◽

Surgical Technique ◽

Pelvic Organ ◽

Vaginal Mesh ◽

Repair System ◽

Mesh Exposure ◽

Anterior Repair ◽

Preliminary Results ◽

Pop Repair

Introduction: Although the use of transvaginal mesh (TVM) in the repair of pelvic organ prolapse (POP) has been restricted, there are still some cases in which TVM may be the most appropriate approach. The TVM Surelift® anterior repair surgical technique has not been described previously. Objective: The aim of this study was to describe the surgical technique and to report our preliminary results regarding efficacy and complications. Methods: A step-by-step description of surgical technique is presented. A descriptive retrospective analysis was performed to evaluate our preliminary results in 17 women who underwent POP repair using the Surelift® anterior repair system in our department between 2014 and 2017. TVM was offered to patients with symptomatic apical (primary or recurrent) or recurrent anterior POP stage ≥2. POP recurrence was classified as asymptomatic anatomic or symptomatic. Patients rated satisfaction with surgery on a scale from 0 to 10. Complications during follow-up were classified according to the International Urogynecological Association/International Continence Society recommendations. Results: Median (IQR) follow-up was 19.9 months (24.8). Two (11.8%) anatomic recurrences were identified, both symptomatic, but neither required further surgery. No cases of pelvic pain, dyspareunia, voiding, or defecatory dysfunction were detected. Two (11.8%) patients presented a <1-cm vaginal mesh exposure (2AaT3S2) requiring partial mesh removal through a vaginal approach. At the end of follow-up, median satisfaction (IQR) with the surgery was 9 (3.1). Conclusion: The Surelift® anterior repair system is effective in correcting apical or recurrent anterior POP, with a high patient satisfaction rate. Complications after this surgery are infrequent and are mostly related to vaginal mesh exposure.

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